Essay: Ritalin

In recent years, more and more kids seem to be on a prescription drug called Ritalin(methylphenidate). This drug is being handed out more and more by doctors as a way of treating Attention Deficit Hyperactivity Disorder, a complex neurological impairnment that prevents kids from concentrating. According to the Drug Enforcement Agency, it rose fron 200 grams per 100,000 people to over 1400 grams per 100,000 people in the last fifteen years. The National Institute of Mental Health estimates that about one student in every classroom is believed to experience the disorder. The rate of Ritalin use in the United States is at least five times higher than in the rest of the world according to federal studies. Are doctors just catching this disabling affliction more often? Or does society just want a convenient way to solve a complicated problem.

Ritalin is a central nervous system stimulant that is somewhat similar to amphetamines. It was created in 1955, classified as a controlled substance in 1971, and became the drug of choice for ADHD in 1981. It is also used in treating narcolepsy. It is thought to activate the brain stem arousal system and cortex, and, like cocaine, works on the neurotransmitter dopamine. It appears to increase the levels of dopamine in the frontal lobe where attention and impulsive actions are regulated. When taken in its intended form under a doctor’s prescritption, it has moderate stimulant properties. There has been a great deal of concern about it’s addictive qualities and adverse affects.

ADHD is a relatively new disorder. It was introduced in 1980, where it was labeled ADD(attention deficit disorder). In the 1950’s, children were simply labeled “hyperkinetic.” The term “hyperactivity” was added in 1987, hence the name ADHD. Not all children have the hyperactivity, and thus are labeled to have ADD. ADD is not treated with Ritalin; antidepressants are more commonly used. One of the problems with the label ADHD is that just because a child may be overly hyper, doesn’t mean the child is not paying attention. The problem is, the child is paying too much attention to too many things at the same time.

ADHD is children’s #1 childhood psychiatric disorder. The prevalence is three times as likely in boys than girls. The children tend to be very bright, but are poor students because they cna’t settle down. They blurt questions out before they are asked. They can’t wait their turn, stop fidgeting their legs and tapping their pencils. They tend to be forgetful, have problems following directions, and lose things easily, as well as their tempers. This behavior occurs constantly. This may be a reason why teachers and school psychologists are adament in their beliefs; these kids are disrupting their classrooms, so they want the problem solved immeditately, and take the “quick fix” approach. Experts believe that more than two million children (3-5%) have the disorder.

Some scientists believe ADHD is a result of a problem in pregnancy ranging from fetal alcohol syndrome to exposure to lead in utero. Others suggest that ADHD is hereditary. Dr. Russel Barkley, of the University of Minnesota reports that nearly half the ADHD children have a parent, and more than one third have a sibling, with the disorder.

Ritalin as prescribed is taken orally, and takes effect in about 30 minutes and lasts for about 3-4 hours. Kids usually take 5-10 mg doses three times a day. Although many experts report that Ritalin is a positive treatment in 9 out of 10 patienst, and many parents and students claim the drug is a benefit in their lives’, there are many who question the drug’s long-term effects, dangers, misdiagnosis, and non-medical abuse. Diagnosis for ADHD isn’t as easy as you think. There is no blood test, no x-ray, or no cat scan to determine a biological cause for the disorder. Teachers, even in preschool strongly advocate the drug(negative reinforcement???). School psychologists are even prescribing the drug before giving an evaluation because there are so many referrals and a lack of school psychologists (1:2100 students). Many times, it has been shown, that psychiatrists who often diagnose for ADHD in children, are disdiagnosing disorders similar to ADHD such as learning disabilities, depression or anxiety disorders; disorders that do not neccessitate Ritalin as a therapy. Some doctors who are reluctant to prescribe Ritalin find that the childeren’s parents just switch doctors and find doctors who will. Unfortunately, this is surprisingly easy. Doctors surveyed by the Archives of Pediatric and Adolescent Medicine said they send ADHD children home in about an hour. The children are not only sent home with just a prescription, but rarely any follow up care of additional therapy is adnministered. Experts in the field of ADHD say behavior modification techniques and extra help in school is a better way in treating the disorder. Since it takes time to sit down and go through therapy sessions, and it takes time for parents to fit tis all into their lifestyle, a pill is much more convenient. There are no long term studies on the effects that it has on children, so many fear what complications may occur later on in life.

Correct diagnosis would occur if doctors would take the time to provide a complete examination of the patient. To make a correct ADHD diagnosis, it is important to review the child’s family history, give abstract cognitive tests, observe their behavior, and run a slew of behavioral exams. Other disorders must be ruled out first. Parents need to make sure a complete evaluation is carried out before putting a pill in a child’s mouth. One would think that every parent would explore every option before relying on medication only.

Diagnosis would also be much easier if doctors could find a flaw in the brain. Several studies have shown that ADHD brains look and function slightly different that “normal” brains. PET(positron emission tomography) has shown that ADHD brains use less glucose in the prefrontal lobe. The prefrontal lobe is the center for impulse control and attention. By using less glucose-or energy, this would then agree with the child’s behavioral problems. Other tests show that there is less electrical activity in the same region of the brain. Nonetheless, these studies have not yet been proven to be the cause for the disorder.

Many people are concerned with the non-medical use of Ritalin, also. Ritalin is a Schedule II controlled substance, which means it is a very powerful drug, and in the same category as cocaine, methadone, and methamphetamines. The Manufacturer of Ritalin, Ciba-Geiby Corporation, cautions doctors that many adverse side effects are possible under normal dosage such as: nervousness, insomnia, decreased appetite, nausea, vomiting, dizziness, heart palpitations, headaches, rise in heart rate and blood pressure, skin rashes, itching, abdominal pain, weight loss, digestive problems, toxic psychosis, psychotic episodes, and severe depression upon withdrawal. Many question if such a drug should be so freely handed out to children because of it’s possible dangerous effects. Parents are even trying to lessen the restrictions on Ritalin so they won’t have to make monthly doctor visits.

It’s rise on the black market has also been increasing. Since it is so widely available, many kids sell the pills for 3-15 dollars a pill. The buyers then crush up the pill and snort it, giving an intense high similar to cocaine. Some also dissolve it in water and inject it intravenously. In these forms, it is highly addictive, and withdrawal symptoms are also similar to cocaine. Some of the side effects at these high doses may be life threatening: loss of appetite(may cause serious malnutrition), tremors and muscle twitching, fevers, convulsions, and headaches(may be severe), irregular heartbeat and respiration(may be profound and life threatening), anxiety, restlessness, paranoia, hallucinations, delusions, excessive repetition of movements and meaningless tasks, and formicaton(sensation of bugs or worms crawling under the skin). It seems to be abused by high school kids and college students predominantly. Although the drug is too complex to manufacture illegally, and it doesn’t create the euphoric effect that cocaine has, it seems to be an aid in studying for final exams. It allows students to stay up all night allowing them to cram much easier.

It is important to remember that too many children in America are suffering from this ailment, and yet too many kids are getting pills instead of proper care. Although Ritalin currently seems to be an effective way in treating Attention Deficit Hyperactivity Disorder, we must not treat this disorder hastily. Our society must realize that prescription drugs can have just as many complications as street drugs. Befor writing out a prescription, or carelessly diagnosing ADHD, we must remember that these are kids we are dealing with. They put all their faith in us to help them, and not just to medicate them.